Surviving myocardial infarction in a conflict-affected setting: depressive symptoms, death anxiety, and fear of war recurrence in Yemen: Cross-Sectional Study

Acute myocardial infarction (AMI) is frequently associated with substantial psychological distress, including depression and death anxiety, which may negatively influence recovery, treatment adherence, and quality of life. In conflict-affected settings such as Yemen, ongoing insecurity, fragile healthcare systems, and fear of renewed war may further intensify psychological burden among cardiac patients. However, evidence regarding these psychological outcomes in post-AMI patients from conflict-affected countries remains limited. To assess the prevalence of depressive symptoms, level of death anxiety, and fear of war recurrence among patients recovering from AMI in Yemen and to examine their associated sociodemographic and clinical factors. A multicenter cross-sectional analytical study was conducted between April to August 2025 among 330 post-AMI patients attending three major referral hospitals in Taiz, Yemen. Data were collected using structured interviews. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II), death anxiety using the Arabic Scale of Death Anxiety (ASDA), and fear of war recurrence using the War Worry Scale (WWS). Descriptive statistics, independent-samples t tests, one-way analysis of variance, Spearman’s rank correlation, and multiple linear regression analyses were performed using SPSS version 27. Overall, 68.8% of participants experienced depressive symptoms ranging from mild to severe. Regarding death anxiety, the mean death anxiety score was 37.77 (SD = 18.71; 95% CI: 35.74–39.80). Mean war recurrence worry was 24.65 (SD 9.20; observed range 10–50). Death anxiety was positively correlated with depressive symptoms (ρ = 0.195, p < 0.001) and worry about war recurrence (ρ = 0.135, p = 0.014). Depressive symptoms were also positively correlated with worry about war recurrence (ρ = 0.160, p = 0.003). Higher psychological distress was significantly associated with lower educational levels, insufficient income, severe chest pain, and unsatisfactory discharge information. Post-AMI patients in Yemen experience substantial psychological burden characterized by depressive symptoms, death anxiety, and fear of renewed conflict. Integrating routine mental health screening and feasible low-cost psychosocial support into post-AMI care may improve recovery and quality of life. However, these findings are based on cross-sectional data, and future longitudinal and implementation studies are needed to determine the effectiveness of such interventions in conflict-affected settings.